Viral hepatitis
Hepatitis
means inflammation of the liver. Many illnesses and conditions can cause
inflammation of the liver, for example, drugs, alcohol, chemicals, and
autoimmune diseases. Many viruses, for example, the virus of mononucleosis and
the cytomegalovirus can inflame the liver. Most viruses, however, do not attack
primarily the liver; the liver is just one of several organs that the viruses
affect. When doctors speak of viral hepatitis, they are using the definition
that means hepatitis caused by a few specific viruses that primarily attack the
liver and are responsible for about half of all human hepatitis.
There
are several hepatitis viruses; they have been named types A, B, C, D, E, F (not
confirmed), and G. As our knowledge of hepatitis viruses grows, it is likely
that this alphabetical list will become longer. The most common hepatitis
viruses are types A, B, and C. Reference to the hepatitis viruses often occurs
in an abbreviated form. (For example, HAV, HBV, HCV represent hepatitis viruses
A, B, and C, respectively.)
Hepatitis
viruses replicate (multiply) in the liver cells. Newly-produced viruses are
released into the blood stream where they can be spread to other organs or to
other persons exposed to the infected blood.
- The
liver helps purify the blood by changing harmful chemicals into harmless
ones. The source of these chemicals can be external, such as medications
or alcohol, or internal, such as ammonia or bilirubin. Typically, these
harmful chemicals are broken down into smaller chemicals or attached to
other chemicals that then are eliminated from the body in the urine or
stool.
- The
liver produces many important substances, especially proteins that are
necessary for good health. For example, it produces albumin, the protein
building block of the body, as well as the proteins that cause blood to
clot properly.
- The
liver stores many sugars, fats and vitamins until they are needed
elsewhere in the body.
- The
liver builds smaller chemicals into larger, more complicated chemicals
that are needed elsewhere in the body. An example of this type of function
is the manufacture of cholesterol.
When
the liver is inflamed, it does not perform these functions well, which brings
about many of the symptoms, signs, and problems associated with any type of hepatitis.
Each viral type has both articles and books describing the details of infection
with that specific virus. This article is designed to give the reader an
overview of the predominant viruses that causes viral hepatitis and should help
the reader choose the subject(s) for more in depth information.
Common types of viral hepatitis
Although
the most common types of viral hepatitis are HAV, HBV and HCV, some clinicians
have considered the acute and chronic phases of hepatic infections as
"types" of viral hepatitis. HAV was considered to be acute viral
hepatitis because the HAV infections seldom caused permanent liver damage with
chronic or fulminant hepatic (liver) failure. HBV and HCV produced chronic
viral hepatitis. However, these terms are not used as frequently because all of
the viruses that cause hepatitis may have acute phase symptoms Prevention techniques and vaccinations have
markedly reduced the common viral hepatitis infections;
Hepatitis A (HAV)
v The hepatitis caused by HAV is an acute illness (acute viral
hepatitis) that never becomes chronic. At one time, hepatitis A was referred to
as "infectious hepatitis" because it could be spread from person to
person like other viral infections. Infection with hepatitis A virus can be spread
through the ingestion of food or water, especially where unsanitary conditions
allow water or food to become contaminated by human waste containing hepatitis
A (the fecal-oral mode of transmission). Hepatitis A typically is spread among
household members and close contacts through the passage of oral secretions
(intimate kissing) or stool (poor hand washing). It also is common to have
infection spread to customers in restaurants and among children and workers in
day care centers if hand washing and sanitary precautions are not observed.
Hepatitis B (HBV)
v HBV hepatitis was at one time referred to as "serum
hepatitis," because it was thought that the only way HBV could spread was
through blood or serum (the liquid portion of blood) containing the virus. It
is now known that HBV can spread by sexual contact, the transfer of blood or
serum through shared needles in drug abusers, accidental needle sticks with
needles contaminated with infected blood, blood transfusions, hemodialysis, and
by infected mothers to their newborns. The infection also can be spread by
tattooing, body piercing, and sharing razors and toothbrushes (if there is
contamination with infected blood). About 6% to 10% of patients with HBV
hepatitis develop chronic HBV infection (infection lasting at least six months
and often years to decades) and can infect others as long as they remain
infected. Patients with chronic HBV infection also are at risk of developing
cirrhosis, liver failure, and liver cancer.
Hepatitis C (HCV)
HCV
hepatitis was previously referred to as "non-A, non-B hepatitis,"
because the causative virus had not been identified, but it was known to be
neither HAV nor HBV. HCV usually is spread by shared needles among drug
abusers, blood transfusion, hemodialysis, and needle sticks. Approximately 90%
of transfusion-associated hepatitis is caused by HCV. Transmission of the virus
by sexual contact has been reported, but is considered rare. An estimated 50%
to 70% of patients with acute HCV infection develop chronic infection. Patients
with chronic HCV infection can continue to infect others. Patients with chronic
HCV infection are at risk for developing cirrhosis, liver failure, and liver
cancer.
Types D, E, and G Hepatitis
v There also are viral hepatitis types D, E, and G. The most
important of these at present is the hepatitis D virus (HDV), also known as the
delta virus or agent. It is a small virus that requires concomitant infection
with HBV to survive. HDV cannot survive on its own because it requires a
protein that the HBV makes (the envelope protein, also called surface antigen)
to enable it to infect liver cells. The ways in which HDV is spread are by
shared needles among drug abusers, contaminated blood, and by sexual contact;
essentially the same ways as HBV.
v Hepatitis E virus (HEV) is similar to HAV in terms of disease,
and mainly occurs in Asia where it is transmitted by contaminated water.
v Hepatitis G virus (HGV) was recently discovered and resembles
HCV; the virus and its effects are under investigation but some investigators
do not recognize it as a cause of hepatitis.
v Patients who already have chronic HBV infection can acquire HDV
infection at the same time as they acquire the HBV infection or, alternatively,
on top of a chronic HBV infection. Patients with chronic hepatitis due to HBV
and HDV develop cirrhosis (severe liver scarring) rapidly. Moreover, the
combination of HDV and HBV virus infection is very difficult to treat.
Risk for viral hepatitis
People
who are most at risk for developing viral hepatitis are:
Ø Workers in the health care professions,
Ø Sewage and water treatment workers,
Ø People with multiple sexual partners,
Ø Intravenous drug users,
Ø HIV patients, and
Ø Hemophiliacs who receive blood clotting factors.
Blood
transfusion, once a common means of spreading viral hepatitis, now is a rare
cause of hepatitis. Viral hepatitis is generally thought to be as much as ten
times more common among lower socioeconomic and poorly educated individuals.
About one third of all cases of hepatitis come from an unknown or
unidentifiable source. This means that a person does not have to be in a high
risk group in order to be infected with a hepatitis virus. In countries with
poor sanitation, food and water contamination with HAV increases risk. Some day
care centers may become contaminated with HAV, so children at such centers are
at a higher risk for HAV infections.
Symptoms and signs of viral hepatitis
The
period of time between exposure to hepatitis and the onset of the illness is
called the incubation period. The incubation period varies depending on the
specific hepatitis virus. Hepatitis A virus has an incubation period of about
15 to 45 days; Hepatitis B virus from 45 to 160 days, and Hepatitis C virus
from about 2 weeks to 6 months.
Many
patients infected with HAV, HBV, and HCV have few or no symptoms of illness.
For those who do develop symptoms of viral hepatitis, the most common are flu-
like symptoms including:
ü Loss of appetite
ü Nausea
ü Vomiting
ü Fever
ü Weakness
ü Tiredness
ü Aching in the abdomen
Less common symptoms include:
ü Dark urine
ü Light-colored stools
ü Fever
ü Jaundice (a yellow appearance to the skin and white portion of
the eyes)
Acute fulminant hepatitis
¬ Rarely, individuals with acute infections with HAV and HBV
develop severe inflammation, and the liver fails (acute fulminant hepatitis).
These patients are extremely ill with the symptoms of acute hepatitis already
described and the additional problems of confusion or coma (due to the liver's
failure to detoxify chemicals) and bruising or bleeding (due to a lack of blood
clotting factors). In fact, up to 80% of people with acute fulminant hepatitis
can die within days to weeks; therefore, it is fortunate that acute fulminant
hepatitis is rare. For example, less than 0.5% of adults with acute infection
with HBV will develop acute fulminant hepatitis, but the rate may be slightly
higher in HCV.
Chronic viral hepatitis
¬ Patients infected with HBV and HCV can develop chronic
hepatitis. Doctors define chronic hepatitis as hepatitis that lasts longer than
6 months. In chronic hepatitis, the viruses live and multiply in the liver for
years or decades. For unknown reasons, these patients' immune systems are
unable to eradicate the viruses, and the viruses cause chronic inflammation of
the liver. Chronic hepatitis can lead to the development over time of extensive
liver scarring (cirrhosis), liver failure, and liver cancer. Liver failure from
chronic hepatitis C infection is the most common reason for liver transplantation
in the U.S.. Patients with chronic viral hepatitis can transmit the infection
to others with blood or body fluids (for example, sharing needles, sexually,
and infrequently by organ donation) as well as infrequently by transmission
from mother to newborn.
Viral hepatitis - Diagnosis
Diagnosis
of viral hepatitis is based on symptoms and physical findings as well as blood
tests for liver enzymes, viral antibodies, and viral genetic materials.
Symptoms and physical findings.
Diagnosis
of acute viral hepatitis often is easy, but diagnosis of chronic hepatitis can
be difficult. When a patient reports symptoms of fatigue, nausea, abdominal
pain, darkening of urine, and then develops jaundice, the diagnosis of acute
viral hepatitis is likely and can be confirmed by blood tests. On the other
hand, patients with chronic hepatitis due to HBV and HCV often have no symptoms
or only mild nonspecific symptoms such as chronic fatigue. Typically, these
patients do not have jaundice until the liver damage is far advanced.
Therefore, these patients can remain undiagnosed for years to decades.
Blood tests
There
are three types of blood tests for evaluating patients with hepatitis: liver
enzymes, antibodies to the hepatitis viruses, and viral proteins or genetic
material (viral DNA or RNA).
Liver
enzymes. Among the most sensitive and widely used blood tests for evaluating
patients with hepatitis are the liver enzymes, called aminotransferases. They
include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase
(ALT or SGPT). These enzymes normally are contained within liver cells. If the
liver is injured (as in viral hepatitis), the liver cells spill the enzymes
into the blood, raising the enzyme levels in the blood and signaling that the
liver is damaged.
The
normal range of values for AST is from 5 to 40 unit s per liter of serum (the
liquid part of the blood) while the normal range of values for ALT is from 7 to
56 units per liter of serum. (These normal levels may vary slightly in the
literature.) Patients with acute viral hepatitis (for example, due to HAV or
HBV) can develop very high AST and ALT levels, sometimes in the thousands of
units per liter. These high AST and ALT levels will become normal in several
weeks or months as the patients recover completely from their acute hepatitis.
In contrast, patients with chronic HBV and HCV infection typically have only
mildly elevated AST and ALT levels, but these abnormalities can last years or
decades. Since most patients with chronic hepatitis are asymptomatic (no
jaundice or nausea), their mildly abnormal liver enzymes are often unexpectedly
encountered on routine blood screening tests during yearly physical
examinations or insurance physicals.
Elevated
blood levels of AST and ALT only means that the liver is inflamed, and
elevations can be caused by many agents other than hepatitis viruses, such as
medications, alcohol, bacteria, fungus, etc. In order to prove that a hepatitis
virus is responsible for the elevations, blood must be tested for antibodies to
each of the hepatitis viruses as well as for their genetic material.
Viral
antibodies. Antibodies are proteins produced by white blood cells that attack
invaders such as bacteria and viruses. Antibodies against the hepatitis A, B,
and C viruses usually can be detected in the blood within weeks of infection,
and the antibodies remain detectable in the blood for decades thereafter. Blood
tests for the antibodies can be helpful in diagnosing both acute and chronic
viral hepatitis.
In acute
viral hepatitis, antibodies not only help to eradicate the virus, but they also
protect the patient from future infections by the same virus, that is, the
patient develops immunity. In chronic hepatitis, however, antibodies and the
rest of the immune system are unable to eradicate the virus. The viruses
continue to multiply and are released from the liver cells into the blood where
their presence can be determined by measuring the viral proteins and genetic
material. Therefore in chronic hepatitis, both antibodies to the viruses and
viral proteins and genetic material can be detected in the blood.
Some Tests for viral antibodies are:
¬ Anti-HAV (hepatitis A antibody)
¬ Antibody to hepatitis B core, an antibody directed against the
inner core (nucleus) of the virus (core antigen)
¬ Antibody to hepatitis B surface, an antibody directed against
the outer surface envelope of the virus (surface antigen)
¬ Antibody to hepatitis B e, an antibody directed against the
genetic material of the virus (e antigen)
¬ Hepatitis C antibody-antibody against the C virus
Viral
proteins and genetic material. Examples of tests for viral proteins and genetic
material are:
Ø Hepatitis B surface antigen
Ø Hepatitis B DNA
Ø Hepatitis B e antigen
Ø Hepatitis C RNA
Other
tests. Obstruction of the bile ducts, from either gallstones or cancer,
occasionally can mimic acute viral hepatitis. Ultrasound testing can be used to
exclude the possibility of gallstones or cancer.
Treatment for viral hepatitis
Treatment
of acute viral hepatitis and chronic viral hepatitis are different. Treatment
of acute viral hepatitis involves relieving symptoms and maintaining adequate
intake of fluids. Treatment of chronic viral hepatitis involves medications to
eradicate the virus and taking measures to prevent further liver damage.
Acute hepatitis Treatment
In
patients with acute viral hepatitis, the initial treatment consists of
relieving the symptoms of nausea, vomiting, and abdominal pain. Careful
attention should be given to medications which can have adverse effects in
patients with abnormal liver function. Only those medications that are
considered necessary should be administered since the impaired liver is not
able to eliminate drugs normally, and drugs may accumulate in the blood and
reach toxic levels. Moreover, sedatives and "tranquilizers" are
avoided because they may accentuate the effects of liver failure on the brain
and cause lethargy and coma. The patient must abstain from drinking alcohol,
since alcohol is toxic to the liver. It occasionally is necessary to provide
intravenous fluids to prevent dehydration caused by vomiting. Patients with
severe nausea and/or vomiting may need to be hospitalized for treatment and
intravenous fluids.
Acute
HBV is not treated with antiviral drugs. Acute HCV - though rarely diagnosed -
can be treated with several of the drugs used for treating chronic HCV.
Treatment of HCV is recommended primarily for the 80% of patients who do not
eradicate the virus early. Treatment results in clearing of the virus in the
majority of patients.
Homeopathy
medicines works well for Acute Hepatitis,
Chronic hepatitis Treatment
Treatment
of chronic infection with hepatitis B and hepatitis C usually involves
medication or combinations of medications to eradicate the virus. Doctors
believe that in properly selected patients, successful eradication of the
viruses can stop progressive damage to the liver and prevent the development of
cirrhosis, liver failure, and liver cancer.
Alcohol
aggravates liver damage in chronic hepatitis, and can cause more rapid
progression to cirrhosis. Therefore, patients with chronic hepatitis should
stop drinking alcohol. Smoking cigarettes also can aggravate liver disease and
should be stopped.
Not
all patients with chronic viral hepatitis are candidates for treatment. Some
patients need no treatment (since some patients with chronic hepatitis B and C
do not develop progressive liver damage or liver cancer).
Medications
for chronic infection with hepatitis B and hepatitis C are not always
effective. Prolonged treatment (6 months to years) often is necessary. Even
with prolonged treatment, rates of successful treatment (defined as complete
and lasting eradication of the virus) often are low (usually less than 80% and
often around 50%).
Some
of the Allopathy medications such as
interferon and ribavirin can have serious side effects, and doses may have to
be reduced.
Homeopathy
medicines works well for Acute Hepatitis,
Fulminant hepatitis. Treatment of acute fulminant hepatitis should be done in
centers that can perform liver transplantation since acute fulminant hepatitis
has a high mortality (about 80%) without liver transplantation.
Viral hepatitis prevention
ü Prevention of hepatitis involves measures to avoid exposure to
the viruses, using immunoglobulin in the event of exposure, and vaccines.
Administration of immunoglobulin is called passive protection because
antibodies from patients who have had viral hepatitis are given to the patient.
Vaccination is called active protection because killed viruses or noninfective
components of viruses are given to stimulate the body to produce its own
antibodies.
Avoidance if exposure to viruses
ü Prevention of viral hepatitis, like any other illness, is
preferable to reliance upon treatment. Taking precautions to prevent exposure to
another individual's blood (exposure to dirty needles), semen (unprotected
sex), and other bodily waste (stool) will help prevent the spread of all of
these viruses.
Hepatitis Vaccinations
Hepatitis
A. Two hepatitis A vaccines are available in the US, hepatitis A vaccine (Havrix,
Vaqta). Both contain inactive (killed) hepatitis A virus. For adults, two doses
of the vaccine are recommended. After the first dose, protective antibodies
develop in 70% of vaccine recipients in 2 weeks and more than 95% of recipients
in 4 weeks. After two doses of the hepatitis A vaccine, immunity against
hepatitis A infection is believed to last for many years.
Individuals
at increased risk for acquiring hepatitis A and individuals with chronic liver
disease (for example, cirrhosis or chronic hepatitis C) should be vaccinated.
Although individuals with chronic liver disease are not at increased risk for
acquiring hepatitis A, they can develop serious (sometimes fatal) liver failure
if infected with hepatitis A and, thus, they should be vaccinated.
Individuals at increased risk of
acquiring hepatitis A are:
Ø Travelers to countries where hepatitis A is common
Ø Men who have sex with men
Ø Illegal drug users (either injection or non-injection drug use)
Ø Researchers working with hepatitis A or primates that are
susceptible to infection with hepatitis A
Ø Patients with clotting factor disorders who are receiving
clotting factor concentrates that can transmit hepatitis A
Ø Some local health authorities or private companies may require
hepatitis A vaccination for food handlers.
Because
protective antibodies take weeks to develop, travelers to countries where
infection with hepatitis A is common should be vaccinated at least 4 weeks
before departure.
Hepatitis B
For
active vaccination, a harmless hepatitis B antigen is given to stimulate the
body's immune system to produce protective antibodies against the surface
antigen of hepatitis B. Vaccines that are currently available in the U.S. are
made (synthesized) using recombinant DNA technology (joining DNA segments).
These recombinant hepatitis B vaccines, hepatitis B vaccine (Energix-B and
Recombivax-HB) are constructed to contain only that part of the surface antigen
that is very potent in stimulating the immune system to produce antibodies. The
vaccine contains no viral component other than the surface antigen, and
therefore, cannot cause HBV infections. Hepatitis B vaccines should be given in
three doses with the second dose 1 to 2 months after the first dose, and the
third dose 4 to 6 months after the first dose. For the best results, the
vaccinations should be given in the deltoid (shoulder) muscles and not in the
buttocks.
Hepatitis
B vaccines are 95% effective. Five percent of vaccinated individuals will fail
to develop the necessary antibodies for immunity after the three doses.
Patients with weakened immunity (such as HIV infection), elderly patients, and
patients undergoing kidney hemodialysis are more likely to fail to respond to
the vaccines.
Hepatitis B vaccine is recommended for:
¬ All infants
¬ Adolescents under 18 years of age who did not receive hepatitis
B vaccine as infants
¬ People occupationally exposed to blood or body fluids
¬ Residents and staff of institutions for the developmentally
disabled
¬ Patients receiving kidney hemodialysis
¬ Hemophiliacs and other patients receiving clotting factor
concentrates
¬ Household contacts and sexual partners of patients infected with
hepatitis B chronically
¬ Travelers who will spend more than 6 months in regions with high
rates of hepatitis B infection
¬ Injection drug users and their sexual partners
¬ Men who have sex with men, men or women with multiple sex
partners, or recent infection with a sexually transmitted infection
¬ Inmates of long-term correctional facilities
All
pregnant women should have a blood test for the antibody to hepatitis B surface
antigen. Women who test positive for hepatitis B risk transmitting the virus to
their infants during labor, and, therefore, infants born to mothers with
hepatitis B infection should receive HBIG in addition to hepatitis B vaccine at
birth. The reason for giving both immunoglobulin and vaccine is that even
though hepatitis B vaccine can offer long lasting, active immunity, immunity
takes weeks or months to develop. Until active immunity develops, the
short-lived, passive antibodies from the HBIG protect the infant.
Unvaccinated
individuals exposed to materials infected with hepatitis B (such as healthcare
workers stuck by a contaminated needle) will need HBIG in addition to hepatitis
B vaccine for the same reason as infants born to mothers with hepatitis B
infection.
Hepatitis C
There
is currently no vaccine for hepatitis C. However, researchers claim preliminary
research results suggest that a vaccine can be made that will be effective
against the multitude of HCV antigenic types that infect humans. They predict
it may become available in about 3 to 5 years.
Prognosis of viral hepatitis
The
prognosis of viral hepatitis for most patients is good; however, this prognosis
varies somewhat depending on the infecting virus. For example those patients
that develop chronic hepatitis may have a worse prognosis because of cirrhosis,
fulminant hepatitis (liver failure), and occasionally death . Symptoms of viral
hepatitis such as fatigue, poor appetite, nausea, and jaundice usually subside
in several weeks to months, without any specific treatment. In fact, virtually
all patients with acute infection with HAV and most adults (greater than 95%)
with acute HBV recover completely.
Complete
recovery from viral hepatitis means that:
ü The hepatitis virus has been completely eliminated from the
liver by the body's immune system,
ü The inflammation in the liver subsides,
ü The patient develops immunity to future infection with the same
virus, and
ü The patient cannot transmit the infection to others.
Unfortunately,
not all patients with viral hepatitis recover completely. Five percent of
patients with acute HBV infection and about 60% of patients with acute HCV
infection develop chronic hepatitis.
Because
the liver works to detoxify substances, this task is compromised during acute
and chronic viral hepatitis infections. Consequently, avoiding items that may
stress the compromised livers function (for example, alcohol, smoking, taking
drugs that require liver processing) should be strongly considered by the
patient to improve their prognosis. .
Viral hepatitis facts
¬ Many illnesses and conditions can cause inflammation of the
liver (hepatitis), but certain viruses cause about half of all hepatitis in
people.
¬ Viruses that primarily attack the liver are called hepatitis
viruses. There are several types of hepatitis viruses including types A,B, C,
D, E, and possibly G. Types A, B, and C are the most common.
¬ Those at risk for viral hepatitis include workers in the health
care profession, people with multiple sexual partners, intravenous drug
abusers, and hemophiliacs. Blood transfusion is a rare cause of viral
hepatitis.
¬ All hepatitis viruses can cause acute hepatitis.
¬ Viral hepatitis types B and C can cause chronic hepatitis.
¬ Symptoms of acute viral hepatitis include fatigue, flu-like symptoms,
dark urine, light-colored stools, fever, and jaundice; however, acute viral
hepatitis may occur with minimal symptoms that go unrecognized. Rarely, acute
viral hepatitis causes fulminant hepatic failure.
¬ The symptoms of chronic viral hepatitis often are mild and
nonspecific, and the diagnosis of chronic hepatitis often is delayed.
¬ Chronic viral hepatitis often requires treatment in order to prevent
progressive liver damage, cirrhosis, liver failure, and liver cancer.
¬ Hepatitis infections can be prevented by avoiding exposure to
viruses, injectable immunoglobulins or vaccines.
Homeopathy Treatment for Hepatitis
Symptomatic
Homeopathy works well for Hepatitis, So its good to consult a experienced
Homeopathy physician without any hesitation.
Whom to contact for Hepatitis Treatment
Dr.Senthil Kumar Treats many cases of Hepatitis, In his
medical professional experience with successful results. Many patients get
relief after taking treatment from Dr.Senthil Kumar. Dr.Senthil Kumar
visits Chennai at Vivekanantha Homeopathy Clinic, Velachery, Chennai 42. To get
appointment please call 9786901830, +91 94430 54168 or mail to consult.ur.dr@gmail.com,
For more details & Consultation Feel free to contact
us.
Vivekanantha
Clinic Consultation Champers at
Chennai:- 9786901830
Panruti:- 9443054168
Pondicherry:- 9865212055 (Camp)
For appointment please Call us or Mail
Us
For appointment: SMS your Name -Age – Mobile Number -
Problem in Single word - date and day - Place of appointment (Eg: Rajini – 30 -
99xxxxxxx0 – Hepatitis – 21st Oct, Sunday - Chennai ), You will receive
Appointment details through SMS
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